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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1415652



Case Details

VAERS ID: 1415652 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal discomfort, Dizziness, Headache, Insomnia, Nausea, Pyrexia, Restlessness, SARS-CoV-2 test, Vaccination site pain, Vision blurred
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Akathisia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Lactation decreased; Suspected COVID-19
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:Inconclusive test; Comments: Inconclusive test
CDC Split Type: GBPFIZER INC2021657593

Write-up: This is a spontaneous report from a contactable consumer received from the Regulatory Authority products Regulatory Agency (UK-MHRA). The regulatory authority report number is GB-MHRA-WEBCOVID-202106041211190630-1KAGO. A 30-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 04Jun2021 (as reported) (Batch/Lot number was not reported) as 1ST DOSE, SINGLE for covid-19 immunisation. Medical history included suppressed lactation, and suspected covid-19 from 03May2020 to 10Jun2020. Patient was not enrolled in clinical trial. Patient was not pregnant. Patient was not currently breastfeeding. The patient''s concomitant medications were not reported. Day of vaccine- 03Jun2021 (as reported). The patient experienced small headache in evening (approx. 4 hours after), sleepless and restless, pain in site of injection, day after fever, hot nausea all day, stomach discomfort, dizzy/woozy, pressure headache and blurred eyesight. The patient experienced nausea on 04Jun2021. The patient underwent lab tests and procedures which included COVID-19 virus test: inconclusive test on an unspecified date. The outcome of events nausea, headache, dizziness and injection site pain was not recovered, of other events was unknown. This is a serious report received with serious criteria medically significant from . No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


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